We live in an era of data. Digital breadcrumbs follow us through nearly every aspect of our daily lives, telling a detailed story of who we are, where we’ve been, what we’ve purchased, what we desire, and much more.
Nowhere is the sheer volume of data more evident than in the world of health care. Today, roughly 30% of the world’s data volume is being generated by the healthcare industry, notes a recent study by RBC Capital Markets. By 2025, the compound annual growth rate of data for health care will reach 36% — 6% faster than manufacturing, 10% faster than financial services, and 11% faster than media and entertainment, the report states.
How do we make sense of this data?
At WithMe Health we have developed a technology platform that allows us to convert this vast sea of health data into actionable insights that allow us to engage members in ways that improve their health and lower their medication costs. We believe that when members are engaged in their care, the best decisions are made. That’s why everything we do is centered around our members, including our purpose-built technology.
mPath360TM is the technology platform that powers our medication experience. It is built around our values of empathy, personalized member pathways, and a whole-health 360 view of our members.
At the core, our mPath360 platform:
Ingests vast amounts of diverse health data to get a holistic view of each member;
Analyzes that data against clinically driven rules to find opportunities for improved outcomes and cost savings; and
Leverages our purpose-built guide engagement platform (CRM) to convert the opportunities into specific actions for our Medication Guides to engage members.
Health organizations are constantly grappling with how best to use the vast amounts of data that are available in today’s healthcare environment, notes Nirav Vira, WithMe’s Chief Technology Officer.
“Ever since the digitization of health records during 2009, health-related data has been collecting and accumulating,” he says. “Everybody is trying to leverage this data and come up with innovative solutions to reduce the burden on the patient and our healthcare system”.
Healthcare data includes such things as pharmacy claims, medical claims, lab summaries, diagnostic data, medical records, social determinants of health, and more. Analyzing the large sets of health data provides a 360-degree view of the member.
“That’s the 360-part of the impact,” Vira says. “You collect as much information as you can to make smarter decisions. You don’t just blindly say, ‘Hey, I see this expensive medication, and here’s one of the three cheaper alternatives. We go deeper into the dataset prior to making any recommendation.”
One approach Vira and his team have taken is to build predictive analytic tools that examine the data to provide a complete picture of each member. They have also started to develop systems that apply artificial intelligence and machine learning (AI/ML), for example, new AI/ML tools around adherence and predictive models around clinical responses to biologics.
Data without any rules is just noise. Having comprehensive sets of clinical rules in place allows us to make use of pertinent healthcare data points, and ultimately create opportunities for engaging members to improve their health. Patient outreaches are more targeted as more data is gathered and effectively analyzed, says Brenda Cheung, Senior Vice President of Clinical Innovation.
This process is enhanced through AI/ML, she says, as well as using more personalized member data that goes beyond clinical and claims information, with the inclusion of social determinants of health (SDoH). These are non-medical factors that shape health outcomes, such as where a person is born, lives, works, and the social processes, policies, and programs that define their living conditions.
“We marry social determinants of health with our clinical data,” Cheung says. “We’re able to then look at the members and tailor our interventions to improve their health.”
Additional ways to manage chronic conditions include discussing avoidance of symptom triggers, assessing appropriateness and responses to treatments, switching to a more effective drug, coaching for better adherence, and avoiding drug-drug interactions.
The predictive nature of our technology allows us to intervene earlier to slow or prevent disease progression, as well as identify potential comorbidities that could lead to future complications. mPath360TM identifies members with chronic conditions or on specialty drugs as candidates for our Disease Management Pathways. Monitoring and regular assessment ensure these members are on the right medications and that they remain responsive to those medications without significant side effects that could lead to future non-adherence.
Cheung notes that ultimately, mPath360TM is an end-to-end solution, taking in large quantities of different health data and making it usable. The goal not only is to help a member determine whether a drug is covered or not, but to find other ways that could improve their health.
“It’s not just the cost of your prescriptions, but we’re able to make sure you’re on the right drug, that you are responding to it the right way, and that it’s working for you.” Cheung says.
Data is processed through sets of clinical rules that ultimately allow WithMe Health to gain insights that result in actionable recommendations designed specifically for the member. These insights are then served to our live Medication Guides through our purpose-built medication guide platform (CRM). This platform provides our Guides with specific tasks on when and how to reach out to members to provide the assistance they need.
Our Medication Guides then proactively reach out to members using our MEDS approach, which is grounded in behavioral science and aids in building trust with members (to read more on our MEDS approach, see the Insights article linked here: MEDS). The Medication Guides also engage directly with providers on the members’ behalf when a change of drugs or doses is appropriate.
The mPath360TM technology empowers our guides to reach members at the right moments through the right channels, and when coupled with the MEDS approach, in the right way to guide member behavior to deliver improved outcomes and cost savings.
In addition to the data analytics, clinical expertise, and direct outreach by our Medication Guides, mPath360TM also includes member-facing technology.
WithMe Health has a member app that allows those who want to be in the driver’s seat to take control of their own medication experience. The app features key functions, such as instantly connecting with a Medication Guide via live chat, searching for a pharmacy or medication, getting price quotes, identifying savings via discount card integrations, tracking prior authorizations, and understanding benefit coverage and deductible status. The app also highlights personalized savings opportunities, says Sally Yang, Head of Product at WithMe.
Yang says forthcoming mPath360TM functionality will include automated multi-channel communication to reach members through the channels they prefer, whether it is the mobile app, text messaging, email, or phone. This functionality will make it easy for WithMe to send targeted and personalized messages to members and prescribers for potential opportunities to achieve savings and improve health outcomes.
Take, for example, Martina who has arthritic psoriasis with symptoms not fully controlled.
Through an analysis of pharmacy claims, medical data, and demographic SDoH data, mPath360TM flags Martina as a candidate for disease pathway management. Our Medication Guides are alerted in the guide engagement platform to reach out to Martina for an initial assessment.
Through that initial conversation, using the MEDS approach to build trust with Martina, our Medication Guide uncovers that Martina hasn’t been adhering to her maintenance medication because it was hard for her to afford it.
The Medication Guide enrolls Martina into WithMe Copay Maximizer program which will help reduce Martina’s out-of-pocket costs and connects Martina with the preferred in-network specialty pharmacy and helps her to arrange for medication delivery. The Medication Guide assesses her symptoms and counsels her on triggers that she can avoid, such as alcohol, and ensures that she adheres to the medication to minimize her symptoms.
Martina can now afford her medication for her psoriatic arthritis. Her flare-ups are greatly reduced and she is getting the full benefit of the medication without needing to increase the dose or switching to a more expensive drug. The Medication Guide continues to follow-up with Martina to monitor her condition and provide support and counseling along her medication journey.
As Brenda Cheung, SVP of Clinical Innovation says, mPath360TM gives us the ability “to look at members and tailor our interventions to improve their health. This decreases the need for more expensive treatment, unnecessary medical visits, and improves quality of life, which then decreases the total costs for the member and the plan.”
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